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Review
. 2017 Dec;7(4):358-366.
doi: 10.1016/j.jceh.2017.10.003. Epub 2017 Nov 7.

Acute and Chronic Rejection After Liver Transplantation: What A Clinician Needs to Know

Narendra S Choudhary  1 , Sanjiv Saigal  1 , Rinkesh K Bansal  1 , Neeraj Saraf  1 , Dheeraj Gautam  2 , Arvinder S Soin  1
Affiliations
Review

Acute and Chronic Rejection After Liver Transplantation: What A Clinician Needs to Know

Narendra S Choudhary et al. J Clin Exp Hepatol. 2017 Dec.

Abstract

While antibody mediated hyper-acute vasculitic rejection is rare in liver transplant recipients, acute and chronic rejection have clinical significance. The liver allograft behaves differently to other solid organ transplants as acute rejection generally does not impair graft survival and chronic rejection (CR) is uncommon. The incidence of acute and chronic rejection has declined in current era due to improved immunosuppressive regimens. Acute rejection generally improves with steroid boluses and steroid resistant rejection is uncommon. CR may improve with escalation of immunosuppression or may result in irreversible loss of graft function leading to retransplantation or death. The current review discusses diagnosis and management of acute and chronic liver allograft rejection.

Keywords: ACR, acute cellular rejection; APCs, antigen presenting cells; CR, chronic rejection; DAIH, de novo autoimmune hepatitis; DDLT, deceased donor liver transplantation; LDLT, living donor liver transplantation; MHC, major histocompatibility complex; acute cellular rejection; antibody mediated rejection; chronic rejection; liver transplantation; steroids.

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Figures

Figure 1
Figure 1
Acute cellular rejection: (A) low power view showing portal inflammation with normal parenchyma, (B) high power view of ‘A’ showing eosiniphils (red colored cells) and ductulitis (circles), (C) ductulitis (red circles) and endothelitis (yellow circles), many plasma cells are visible between 2 yellow circles, (D) Endothelitis.
Figure 2
Figure 2
Chronic rejection: (A) low power view shows atretic portal tracts (red circles) and an area of foamy degeneration, (B) immunohistochemistry (CK 19) image showing CK 19 staining in only 1 (upper) out of 3 portal tracts (marked by red circles), (C) focal CK19 staining (degenerating duct), (D) no CK19 staining is visible in this portal tract (within red circle).
Figure 3
Figure 3
Plasma cell rich rejection: (A and B) interface hepatitis, (C) many plasma cells (white arrows), (D) a cluster of plasma cells (within red circle).
See this image and copyright information in PMC

References

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Further reading

    1. Christina S., Annunziato R.A., Schiano T.D. Medication level variability index predicts rejection, possibly due to nonadherence, in adult liver transplant recipients. Liver Transpl. 2014;20:1168–1177. - PMC - PubMed